<div class="am-u-sm-12 widget main-w" >
	<ol class="am-breadcrumb">
		<li><a href="{:url('/admin/index')}">首页</a></li>
		<li><a href="{:url('/admin/car/index')}">业务管理</a></li>
		<li><a href="{:url('index')}">加油管理</a></li>
		<li class="am-active">{$item.policy_number?保险编辑:添加保险}</li>
	</ol>
	<form class="am-form-inline tpl-form-border-form" enctype="multipart/form-data" data-ajax="1" data-check="1">
		<div class="am-u-sm-8">
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-6 cl-p">
					<label for="user-name" class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;">车牌号： </label>
					<div class="am-u-sm-8 cl-p">
						<input type="hidden" class="CarId" name="car_id" value="{$item.car_id}" />
						<input type="text" class="am-form-field tpl-form-no-bg  car_number" style="line-height: 21px;" data-check="require" data-msg="请选择车辆" value="{$item.number}" placeholder="点击选择车辆" readonly="">
					</div>
				</div>
				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;" >保单号： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="policy_number" value="{$item.policy_number}" data-check="require" data-msg="保单号不能为空" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>

			<div class="am-u-sm-12" style="margin-bottom:10px ;">

				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;" >保险种类： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<select name="policy_type" >
								<option value="1">交通强制险</option>
								<option value="2">商业险</option>
							</select>
						</div>
					</div>
				</div>
				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;" >购买金额： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="policy_charge" value="{$item.policy_charge}" data-check="require" data-msg="购买金额不能为空" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;" >保险公司： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="insurance_company" value="{$item.insurance_company}" data-check="require" data-msg="保险公司不能为空" style="line-height: 21px;" />
						</div>
					</div>
				</div>
				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;" >投保人： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="policy_holder" value="{$item.policy_holder}" data-check="require" data-msg="投保人不能为空" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>

			<div class="am-u-sm-12" style="margin-bottom:10px ;">

				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p am-text-truncate" style="line-height: 35px;" >保险公司联系人： </label>
					<div class="am-form-group am-u-sm-8 cl-p" >
						<div class="am-u-sm-12 cl-p">
							<input type="text" class="tpl-form-input" name="linkman" value="{$item.linkman}" data-check="require" data-msg="保险公司联系人不能为空" style="line-height: 21px;" />
						</div>
					</div>
				</div>
				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p am-text-truncate" style="line-height: 35px;" >保险公司联系电话： </label>
					<div class="am-form-group am-u-sm-8 cl-p" >
						<div class="am-u-sm-12 cl-p">
							<input type="number" class="tpl-form-input" name="phone" value="{$item.phone}" data-check="require" data-msg="保险公司联系电话不能为空" style="line-height: 21px;" />
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;" >投保时间： </label>
					<div class="am-form-group am-u-sm-8 cl-p" >
						<div class="am-u-sm-12 cl-p">
							<input type="text" name="start_date" value="{$item.start_date}" class="am-form-field tpl-form-no-bg am-margin-top-xs" data-check="require" data-msg="请选择投保时间" placeholder="发布时间" data-am-datepicker="" readonly="">
						</div>
					</div>
				</div>
				<div class="am-u-sm-6 cl-p">
					<label class="am-u-sm-4 am-form-label cl-p" style="line-height: 35px;" >到期时间： </label>
					<div class="am-form-group am-u-sm-8 cl-p">
						<div class="am-u-sm-12 cl-p">
							<input type="text" name="end_date" value="{$item.end_date}" class="am-form-field tpl-form-no-bg am-margin-top-xs" data-check="require" data-msg="请选择到期时间" placeholder="发布时间" data-am-datepicker="" readonly="">
						</div>
					</div>
				</div>
			</div>

			<div class="am-u-sm-12" style="margin-bottom:10px ;">

				<div class="am-u-sm-12 cl-p">
					<label class="am-u-sm-2 am-form-label cl-p" style="line-height: 35px;" >备注说明： </label>
					<div class="am-form-group am-u-sm-10 cl-p" >
						<div class="am-u-sm-12 cl-p">
							<textarea name="ps" rows="10">{$item.ps}</textarea>
						</div>
					</div>
				</div>
				
			</div>
			<div class="am-u-sm-12 " style="margin-bottom:10px ;">
					<label class="am-u-sm-2 am-form-label cl-p" style="line-height: 35px;" >图片上传： </label>
					<div class="am-u-sm-10 cl-p">
						<div class="am-form-group am-u-sm-3">
							<div class="am-u-sm-12 am-margin-top-xs">
								<div class="am-form-group am-form-file showimg">
									<div class="tpl-form-file-img">
										<img src="{:CxImg($item.policy_img)}" alt="保险图片">
									</div>
									<button type="button" class="am-btn am-btn-danger am-btn-sm"><i class="am-icon-cloud-upload"></i> 添加保险图片</button>
									<input id="doc-form-file" name="policy_img" type="file" multiple="">
								</div>
							</div>
						</div>

					</div>
				
				
			</div>
			<div class="am-u-sm-12" style="margin-bottom:10px ;">
				<div class="am-u-sm-4">&nbsp;</div>
				<div class="am-u-sm-4">
				<button type="button" class="am-btn am-btn-sm am-btn-primary am-radius keep">保存</button>
				<button type="button" class="am-btn am-btn-sm am-btn-secondary am-radius back">返回上一页</button>
				</div>
				<div class="am-u-sm-4">&nbsp;</div>
			</div>
		</div>
	</form>
</div>